An important part of routine health care maintenance for all children is the surveillance of growth and physical development is extremely important. Growth and development in children with CP have not been rigorously studied, and normal patterns have not been established. Puberty is a time of great physical change for children and the differences in the growth and development of children with CP become more marked. The physical changes during puberty of children with CP have not been systematically investigated. Likewise, the role of nutritional and hormonal influences on the onset of progression of puberty in children with CP has not been investigated. The North American Growth in Cerebral Palsy Project (NAGCPP) is a multi-center research program developed in 1996 to address the lack of scientific data regarding growth and nutritional status in children with CP. The core study of NAGCPP is an anthropometric study of growth in a population based, representative sample of children with CP. NAGCPP also includes multiple nested studies addressing more specific issues related to growth and its impact on maturation, functional abilities, general health, and quality of life. This proposal outlines a plan for a new nested study that utilizes a sub-sample of subjects from NAGCPP in Virginia and North Carolina, unique research facilities (General Clinical Research Centers), and clinical research expertise at both institutions. The hypotheses to be investigated are: a) The timing and tempo of growth and sexual maturation in children with CP differs from normal children, and b.) Nutritional and hormonal mechanisms are responsible for these differences. The study is a longitudinal cohort study in which 20 girls and 20 boys will be closely evaluated every 6 months over a 2 year period. We will assess growth skeletal maturation body composition, sexual maturation, functional abilities, general health, hormonal levels, and other biochemical markers of growth and nutrition. Results will be compared to a parallel group of able-bodied, normal subjects who are part of an ongoing NIH-funded study at Virginia. In addition, the impact of growth and mutation on functional abilities and health-related quality of life will also be investigated. A longitudinal study of growth, body composition, hormone levels,. Physical maturation, functional abilities and quality of life in children with cerebral palsy has never been undertaken.